Preserving Antibiotics and Combating Resistance to Them: A Joint Statement from 27 National Health Groups

GrantWatch Blog invited the author, who is director of the Center for Disease Dynamics, Economics, and Policy, to write this post focused on the center’s telebriefing, which was held in November. He most recently wrote for Health Affairs in 2011 as lead author of an article on India’s vaccine deficit.

The joint statement (available here) emphasizes a number of issues that have been core areas of focus for Extending the Cure, a research and consultative effort led by CDDEP and funded in part by the RWJF’s Pioneer Portfolio. As Portfolio director Brian Quinn mentioned in the telebriefing, Pioneer grantees’ goals lie in developing “innovative approaches to some of the biggest problems faced in health and health care.” Through Extending the Cure, CDDEP has been producing independent research since 2007 to identify and evaluate potential policy solutions to incentivize the judicious use of existing antibiotics and the timely development of new ones.

Since their introduction in the 1940s, antibiotics have saved millions of lives and become a cornerstone of modern medicine. Unfortunately, the more we expose disease-causing bacteria to antibiotics, the quicker they evolve mechanisms to resist them. The issue grows more urgent each year, as the spread of resistant organisms is outpacing our ability to invent new drugs. Unless collaborative policy action is taken, we are facing the real danger of returning to an era in which simple bacterial infections are deadly or very costly to treat.

“We must remind ourselves that antibiotics are a shared resource and every individual should consider how each prescription or use of antibiotics impacts the overall effectiveness of the antibiotic arsenal,” said the CDC’s Arjun Srinivasan during the briefing. “How we use and protect these precious drugs must fundamentally change.”

The urgency of this problem is further highlighted by new CDDEP research that was released concurrently with the joint consensus statement. With the latest iteration of our online tool ResistanceMap, which visualizes trends in antibiotic use and resistance, CDDEP has revealed new and concerning patterns of antibiotic use and resistance in the United States.

Parts of the country continue to use antibiotics at high rates that are unjustified by their burden of bacterial infections, with states in the Southeast consuming more than twice as many antibiotics as those in the West. Moreover, this regional gap is widening over time, underscoring the need for locally tailored interventions in certain parts of the country.

The release of the consensus statement and CDDEP’s new resistance data sparked a productive discussion between members of the press and the diverse group of experts present at the telebriefing. One topic touched upon was the use of antibiotics in animals, which is emphasized in the final two principles of the consensus statement. Gail Hansen, a public health veterinarian with the Pew Charitable Trusts, remarked that the CDC, Food and Drug Administration, and the US Department of Agriculture have all agreed that animal antibiotic use contributes to resistance. The Food and Drug Administration now has a “voluntary policy to have antibiotics not be used for growth promotion for animals,” but its impact “remains to be seen,” Hansen said.

The current lack of enforceable policies on that front is worrisome, in my view.

Maryn McKenna, journalist and author of Wired’s Superbug blog, also raised an important point about the need for an increase in public awareness of antibiotic resistance. For this change to happen, messaging campaigns must be more vocal about the consequences of continuing to ignore this problem. Existing campaigns that emphasize stewardship and preservation of antibiotics, like the CDC’s Get Smart Week, could also make a bigger impact if given more funding.

Last month’s telebriefing and CDDEP’s new ResistanceMap findings received notable attention in the press, including articles or blog posts in the Huffington Post, Wired, USA Today, and the Los Angeles Times. Although this issue may seem evergreen to those who have been following it, resistance will continue to worsen and our supply of working drugs will continue to be depleted unless decisive action is taken.

To make sure that the frightening prospect of a post-antibiotic world does not become a reality, coordinated efforts must be made across key groups of stakeholders. As David Relman, president of Infectious Diseases Society of America, remarked at the telebriefing, “It will take all of us—consumers, health care providers, researchers, policy makers, industry, and others—to tackle this problem.”

In early 2013, Extending the Cure will publish a final report outlining policy recommendations for saving our precious antibiotic resources.

To listen to a complete recording of the joint statement telebriefing, please go here.